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36 Cards in this Set

  • Front
  • Back
SPI syndromes
concussion
incomplete
complete
Complete SCI
no sensory or voluntary motor fxn below level of injury
intact BC reflex
<5% chance recovery
Incomplete SCI
some neuro fxn below injury level
intact BC reflex
(5 ex. syndromes seen later)
Mech of INjury
Primary: Contusion, Compression, Stretch, Laceration
Secondary: ischemia, edema (accompanies all SCI 2ndary to vasc disruption and vasoactive subs)
Axial loading
spinal compression, force transmitted via scolumn, like hit to top of head diving
mech: narrowing of IV spaces
shifts IV discs
fractures
Subluxation
incomplete dislocation, still articular continuity
25% involve 1 facet
>50% involve 2 facets=complete dislocation!
mech: any direction of force-w/head flexed, hangman's
Hangman's Fracture ("Tip")
C2 fx/ subluxation/ dislocation on C3=death

(vs. C5 on C6 snaps neck)
Occipitoatlantal dislocation
Fatal
neuro deficit
c1 flacid quadriplegia
needs rigid immobilization
Jefferson Fx
Bust fx of c1 atlas ring
caused by ax-loading on head
multiple fxs of ring
no cord compression- safe
4 mo immobilized
C1-C2 dislocation
w.out fx: odontoid failed
w. fx: odontoid less likely assoc with severe neuro inj
immob until odontoid healed
odontoid fx
c2
type I-III, III=unstable with lots of front/back motion causing compression
Unstable Axial Compression Fx
Principle of ring: can't break just one side!
Clay Shoveler fx
ripped section of spinous process
no neuro deficit
hangman's fracture
lethal
cord completely crushed
bilat fx of post arch of s2
spondylolysis
hyperextension
chance fx
horizontal fx through vertebra
severe crush
area sags down
bleeding and inj to sc
Laminectomy
decompression of sc
indications: - Quickenstedt test (blocked flow of CSF when pressure applied)
bony fragments in scanal
acute ant scord syndrome
Contraindications: acute ant cervical scord synd, recovers, met/pulm complications, other severe inj req sx
Transection cord injury
partial/complete severing of scord
complete: cervical spine:quadriplegia, incont, resp paralysis
<T1: incont, paraplegia
Rectal Exam
Bulbocaverosus reflex-anal sphincter contraction/wink
involved S1-3 nerve roots and reflex arch
absense of reflex=continuation of spinal shock
us resolves in 48 hrs and BC returns
Cauda Equina Synd
incomplete SCI
Herniated L2
crushes spinal cord
no BC reflex
inj to lumbosacral roots
sensorymotor & bowel/ bladder deficits
Conus Medullaris Synd (S3-5)
incomplete SCI
L1 burst inj
persistent loss of BC reflex
saddle anesthesia
sphincter loss
intact LE motor/sensory
Central Cord Synd.
incomplete SCI
hyperextension, tumor
paresis/plegia of arms>legs
post column spared
more sensation in upper ext
sacral sparing
good prognosis
Ant Cervical Cord Synd
incomplete SCI
hyperflexion
motor, pain, temp loss
dorsal column preserved
autonomic dysfunction
sacral sparing
50% recovery
Ant Spinal Cord Infarction
incomplete SCI
common ant and thoracic
acute paralysis below lesion
dissociated sensory loss (pain/temp)
post column fxn remains
loss of sphincter fxn
Brown-sequard may occur
Brown-Sequard
incomplete SCI
penetrating trauma (tumor, etc)
IPSILATERAL:motor paralysis, loss of touch/proprio below lesion, hyperanesthesia
CONTRALATERAL pain/temp loss 1 or 2 seg below lesion
Nerve Root LEsion
isolated, at any level
partial or complete
radicular pain
sensory dysfunction
weakness
hyporeflexia or areflexia
Steroids
to manage SCI
reduce body response to inj
reduce swelling and cord pressure
administer within 8hrs
1.Methylprednisolone - Solu-medrol
2.Dexamethasone- decadron or hexadrol (more potent than #1)
both lessen cap dilation and permeability
Managing SCI
Body spica (w/mobility)
Knight-taylor brace
Surgical fixation
Pediatric spine
up to 10:epiph growth
over 10: adult
Atlantooccipital (ped)
rare
atlantoaxial (ped)
trauamatic lig disruption
lig laxity rel to local inflamm
rotary reformity
odontoid separation
pain, no neuro def, translation of C1 on C2 by forward slip
Atlantoaxial Rotatory Displacement (ped)
common cause of TORTICOLLISIS
cause unknown
spontaneous onset w/URI
Sternocleidomastoid:neck spasms, head tilted to affected side, rotated to opp side w/slight flexion
Odontoid Fx (ped)
epiphys slip
flexed head with acute trauma(drop kid on head)
Schuermann's Disease
(peds!)
THORACIC KYPHOSIS
wedge of 5 adj vertebra=dorsal hump
end plate irregularity, disc space narrowing
can be hereditary
inhibition of growing, wedging
better by forward flexing, releved by rest
traumatic SPONDYLOLYSIS
ped- MC at L5-S1
congenital or microtrauma to growth plate
lower back pain in kids <10, familial
aggravated by activity, better with rest
no nreve root compression
hamstring tightness
PARS INTERARTICULARIS defect: Scotty dog sign
neck failed to unite/broken to allows slipage of L5 on S1
feels better to lean forward
SPONDYLOLYSTHESIS
ped spondylolysis that slips

grades 1-3 (3=severe)
onset teen/elderly
microtrauma
increased lordosis (big butt)
L4 slips on L5, pain worse with sitting
Sculiosis
25deg:Brace
>45deg:Sx